Urology Coding Alert

Question: Can I bill for a prostate block (64450) with a prostate biopsy and ultrasound guidance (55700 and 76942)?


Texas Subscriber
Answer: For Medicare patients, you shouldn't separately report 64450 (Injection, anesthetic agent; other peripheral nerve or branch) with 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) and 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation).

Medicare states that all "surgical" anesthesia the urologist administers during this procedure is included in the global fee. Therefore, Medicare will not separately reimburse for what it feels is "surgical anesthesia."

Tip: Some private carriers, however, may separately reimburse for the periprostatic (64450) block, so bill for the anesthesia but also be sure to check with your individual carriers. Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.